On The Pen: The Weekly Dose 5.21.24

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[@cloakster]

Nice ‘cast. And tip of the hat to Clark on hunting down that conference info. 🎩
Lilly didn’t actually say much of anything new about Reta and Orforglipron, but the cool thing is they collected most of the comprehensive Phase 2 results data for each, and put it all into one presentation PDF for each (instead of it all being piecemeal).
Hadn’t seen the graph on increased heart-rate/tachycardia w/Reta before now though, and it’s a little worrisome.
We knew about the issues with Reta allegedly causing moderate heart arrhythmias at high doses, but +10 beats per minute too at the top dose? 😯
Yes, it does fall some over time, but not that much… still +6 bpm at 48 weeks. I know all GLP-1s cause mild and usually transitory heart rate increases, but this seems excessive.
Lilly *really* needs to get their arms around this, likely via a gentler titration schedule and maybe reducing the top dosage. They’ve apparently *already* slowed the titration in Phase 3… for 12mg, it’s now 2/4/6/9/12, whereas in the Phase 2 it was 2/4/8/12.
Hopefully that helps, but dunno if it’ll be enough by itself.
On Orforglipron: Are peptide orals really going to be easier to manufacture than Orforglipron, when you need such a crazy amount of API for them?
Recall that 50mg Rybelsus doesn’t need just 20 times more semaglutide than 2.4mg Wegovy, but about *150 times more,* since Rybelsus is daily, not weekly like Wegovy. 😯
And Novo’s said that API is the holdup in releasing high-dose (25 and 50mg) Rybelsus. So maybe Lilly’s oral approach isn’t a disadvantage? Guess we’ll see.
On South Park’s ‘Ozempic special’… it’ll probably be funny, it probably won’t be insightful or helpful. 🤔
I like the show, but whenever Parker and Stone try to do meaningful social commentary, they tend to faceplant pretty hard. It’s just not what they’re good at, so hopefully they don’t even try. 🤷‍♂️
Oh, and sry ‘bout your flooded studio again, Dave. You’re sure having a bad run of luck lately. 😕

[@djbosnick1072]

Thanks!

[@ManOnTheMounjaro]

Thanks so much!

[@djbosnick1072]

Thank you and your team Dave, for all you do

[@clarkkent7973]

Awesome podcast! How is there so much news in one week? I am looking forward to the "Dave reacts to South Park: End of Obesity" video

[@SueUTube]

Yes. There was a ton of news this week.
I don't think I'm ready for svelte Cartman.

[@sashai8660]

Thanks Dave.

[@djbosnick1072]

Are the people that you've heard of who get their Zepbound approved through Medicare, or is it only Wegovy. I started on Zep, but i'm on compounded tirz at present due not only shortages, also expense because my aetna ins doesn't cover. On 7/1 I'll move over to Medicare. Since I have stroke history, I wonder if I have any hope of getting Zep on Medicare or if it is going to have to be wegovy that I try to get my doc to push approval for.

[@cloakster]

Pretty sure Tirzepatide/Zepbound doesn’t have an FDA indication for CVD issues yet (though it is in clinical trials for such, IIRC)… so you’re probably looking at Wegovy, at least for now.
And yeah, sucks that Medicare won’t cover GLP-1s for obesity.

[@kathytodd983]

Best telehealth for compound? Thx!